Jump to content


Photo

Half of ACC disputes are over elective surgery


  • Please log in to reply
1 reply to this topic

#1 BLURB

BLURB

    Advanced Member

  • Members
  • PipPipPip
  • 88 posts
  • RegionCambridge

Posted 21 November 2017 - 05:29 PM

https://www.stuff.co...d-fake-injuries
 
Half of ACC disputes are over elective surgery
MADISON REIDY
Last updated 17:40, November 21 2017


1511239227447.jpg
More than 50,000 New Zealanders asked ACC to pay for their elective surgery last year.

Refusal to pay for elective surgery topped the list of the 10 most common disputes over Accident Compensation Corporation decisions last year.

About 5600 formal reviews were taken by claimants against the state insurer in the year to June 2017.

ACC figures show 2330 of those complaints were over elective surgeries to treat injuries.

To reach a formal review, clients must appeal to ACC within three months of it making a decision to decline to cover the cost of a surgery.

READ MORE: Health insurer Southern Cross battles ACC

The reviews are heard by dispute service firm Fairway Resolution. ACC's decisions were upheld in 82 per cent of hearings in the year to June.

Almost 6000 ACC claimants took formal action against the state insurer this year.
1511239227447.jpg
SUPPLIED

Almost 6000 ACC claimants took formal action against the state insurer this year.

ACC specialist lawyer Warren Forster said the large number of surgery reviews was due to ACC declining so many elective surgery applications.

ACC received 51,270 claims to cover elective surgery in the past year.

Forster said claimants had already been told by a surgeon that ACC should pay, so to have it declined against a medical professional's opinion was often surprising.

"About 10 to 20 per cent who have a declined surgery review it."

ACC spokesman James Funnell said elective surgeries were often declined due to pre-existing conditions.
1511239227447.jpg
ACC data for the 2016 to 2017 financial year shows almost half of its reviewed decisions were for declined elective ...
STUFF

ACC data for the 2016 to 2017 financial year shows almost half of its reviewed decisions were for declined elective surgeries.

If ACC accepts a claim for elective surgery the claimant was placed higher on the hospital waiting lists and was entitled to lost income compensation while they recovered from their procedure, he said.

"There are significant benefits of having surgery approved by ACC, including earnings-related compensation while recovering, and reduced waiting times compared with the public health waiting list, so these are potentially drivers that contribute to the review rate for surgery decisions," Funnell said.

However those benefits were not factored into ACC's decision to decline a claim.
ACC specialised lawyer Warren Forster says fewer formal reviews against ACC doesn't suggest a more just system.
1511239227447.jpg
SUPPLIED

ACC specialised lawyer Warren Forster says fewer formal reviews against ACC doesn't suggest a more just system.

The second most common reason claimants went to formal review last year was because ACC deemed that a direct cause for the injury could not be established.

More than 700 reviews contested ACC's decisions for personal injury cover in the past year.

ACC covers the costs of an injury if it was caused by accident, sexual violence, birth, or was the result of a gradual condition from working.

​Disputes over cover made up more than a third of this year's top 10 reviews.
Ad Feedback

ACC claimants filed almost 600 reviews against refusal to pay for treatment, placing it fourth in the top 10.

There were 232 reviews against gradual process cover and 145 against accident cover among the top 10, where the ACC refused to believe that injuries happened by accident.

Forster said those numbers were low compared to the average 50,000 cover claims that ACC declined each year.

ACC decisions to suspend compensation payments were the third most reviewed, and of most concern, he said.

He said these people had typically been receiving ACC payments for a long time.

"ACC has had enough of these people," he said.

Payments were typically suspended because the ACC found there was "no causal link" between a claimant's injury and the reason for the payments.

Over the past seven years, the number of disputed decisions have almost halved - from 9800 in 2009 to 5600 last year.

ACC deputy chief executive Jim Stabback said the organisation tried to make as much information available to claimants to reduce the number applying for formal reviews.

"We have been working for five to six years to drive it [formal review numbers] down … [But] there are incidences where clients feel it is necessary to review our decisions."

Forster said fewer formal reviews did not suggest a more just ACC system.

"Has the number halved because less people are p...ed off or because people think there is not much point in dealing with them?"

This year the number of reviews rose 0.2 per cent on last year.

Almost two million people made new ACC claims last year.

A previous version of this story incorrectly stated that ACC took the costs associated with elective surgeries into account when deciding whether to approve a claim.

- Stuff
 
https://www.stuff.co...d-fake-injuries


  • 0

I have many issues with the way AON, Catalyst and ACC managed my 1992 lower back injury claim between 2000 and 2002.

Not only did Leanne MacDonnell & Dr Robert Percival interfere with the assessment process, they wrote lies about me in my files.


#2 Admin

Admin

    Management

  • Administrators
  • 574 posts
  • RegionNelson

Posted 21 November 2017 - 05:32 PM

Warren Forsterhttp://accforum.nz/t...warren-forster/


  • 0

"If everybody is thinking alike, then somebody is not thinking." - Gen. George S. Patton Jr.